Gender and Racial Discrimination in Pay and Promotion for NHS Nurses
| Author | Stephen Pudney,Michael A. Shields |
| DOI | http://doi.org/10.1111/1468-0084.0620s1801 |
| Date | 01 December 2000 |
| Published date | 01 December 2000 |
GENDER AND RACIAL DISCRIMINATION IN PAY
AND PROMOTION FOR NHS NURSES
Stephen Pudney and Michael A. Shields
I. INTRODUCTION
Since its establishment in the post-war period, the National Health Service
(NHS) in Britain has been subject to allegations that gender and racial
discrimination are a feature of the internal labour market for quali®ed
nursing staff (see Beishon et al., 1995; Davies and Rosser, 1986; Ellis,
1990; IHMS, 1995). Government concern about discrimination in the NHS
has led to `a fair process for determining reward' and `equality of
opportunity' being identi®ed as prime objectives in the Department of
Health's recent Consultancy Document `Working Together: Securing a
quality workforce for the NHS' (DOH, 1998).
Labour market discrimination, of course, is not only a characteristic of the
nursing profession in Britain, but also of the labour market more generally
(see, for recent evidence, Blackaby, Clark, Leslie and Murphy, 1994, 1997,
Blackaby, Drinkwater, Leslie and Murphy, 1997; Jones and Makepeace,
1996; Groot and Maasen van de Brink, 1996; Shields and Wheatley Price,
1999; and Wright and Ermisch, 1991). One conclusion from this literature is
that pay differentials between men and women, whites and non-whites, are
not fully explained by differences in their observable human capital charac-
teristics. For example, Wright and Ermisch (1991) found, using data from the
1980 `Women in Work Survey', that less than two-thirds of the 48% earnings
differential between men and women could be attributed to differences in
labour market characteristics. Despite the continued existence of a signi®cant
gender pay differential in Britain,1the last two decades have, however, seen a
considerable improvement in the relative position of women, which, in part,
is attributed to the success of equal opportunities legislation introduced since
the early 1970s (see, for example, Blackaby, Clark, Leslie and Murphy, 1997;
Tzannatos, 1987, 1988).
On race, Blackaby et al. (1994) found that non-whites, having more
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We are grateful to the Policy Studies Institute and the Department of Health for providing
access to the data analysed in this paper. We would also like to thank seminar participants at the
University of Leicester and the European Economics Society Conference (Spain, 1999) for
valuable comments on an earlier version.
1See Blau and Kahn (1996) for international comparisons of gender wage differentials.
favourable observed characteristics should have experienced a 4.4% wage
advantage over whites between 1983 and 1989, whereas the actual wage
differential was 12.1% in favour of whites. In contrast to the case of gender,
it is generally accepted that equal opportunities legislation has been less
successful in reducing the white/non-white pay differential, with the latter
group of workers becoming increasingly concentrated in the lower percen-
tiles of the pay distribution (Blackaby et al., 1994).
Some studies have suggested that these pay differentials are largely
attributable to the fact that women and ethnic minorities have lower promo-
tion rates and are thus less likely to be found in higher paying jobs. There is
then a `glass ceiling' preventing members of disadvantaged groups from
advancing to the higher levels of the occupational ladder.2Jones and
Makepeace (1996), using personnel data from a large ®nancial company,®nd
some evidence that women have to meet tougher promotion criteria than men
and conclude that discrimination is evident in all promotions beyond the
bottom of the job ladder. In contrast, however, Groot and Maassen van de
Brink (1996), using data from the British Household Panel Survey (BHPS),
®nd evidence to suggest a rather different discriminatory mechanism. They
distinguish between jobs with potential for promotion and jobs with few
prospects and ®nd that women are less likely to be appointed to the former.
Booth et al. (1998) also use data from the BHPS, but interestingly ®nd no
signi®cant gender differences in the probability of promotion for full-time
workers. Women, however, are found to receive a lower reward to promotion
than men, suggesting that, because of `sticky ¯oors', promotion is not a
panacea for the general disadvantage faced by women in the labour market
(Booth et al., 1998). This, however, is unlikely to be a feature of NHS
nursing, which is still characterised by rigid pay scales.
The recent literature on gender promotion differentials has been moti-
vated by the model of Lazear and Rosen (1991), which predicts that women
must have a greater ability than men if they are to be promoted. This is
because women generally have productive opportunities in the household
that men do not and thus have a higher risk of turnover. This reduces the
expected net bene®ts to the ®rm from training and promoting women and so
fewer are observed in the higher levels of the ®rm.
In this paper, we examine the promotion process for nurses working in
the NHS in the hope of informing the debate on the workings of internal
labour markets. Apart from the suggestion of discrimination in the NHS
nursing labour market, the nursing occupation is an important subject of
study for other reasons.3Firstly, demographic trends and increasing health
2See Davidson and Cooper (1992) for a thorough discussion of the concept of a `glass ceiling'.
3There are, however, few econometric studies which have examined the workings of the labour
market for professional nurses in Britain (see Beaumont and Elliot (1992) and Phillips (1996)).
This situation contrasts with that of the US (see Holtmann and Idson (1993), Ault and Rutman
(1994), Hirsch and Schumacher (1995), Krall (1995), Lane and Gohmann (1995), Ahlburg and
Mahony (1996) and Schumacher (1997)).
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care demands mean that nursing is an increasingly important sector of the
labour market. However, it is also one in which there is a crisis of morale
and recruitment (UNISON, 1996). This crisis may be linked to the NHS
promotion process ± only 20% of white, 13% of black and 12% of Asian
NHS nurses express satisfaction with their chances of promotion (Beishon
et al., 1995). A second distinctive feature of nursing is that it is one of the
`caring' professions, where considerations other than the usual economic
ones might be expected to play a role in pay and promotion. It is also a
female-dominated profession, with over 90% of quali®ed nurses being
women. A consequence is that the majority of those who make the
promotion and hiring decisions are female (only 12% of nurse managers are
male in our sample) and this raises questions about the origin and extent of
any gender discrimination. In addition, ethnic minorities are also over-
represented in nursing, with 6.3% of female nurses and 14.7% of male
nurses from ethnic minorities, compared with 3.6 percent and 3.9% in all
employment (Beishon et al., 1995). Nursing is also an unusual profession in
that it is dominated by the public sector, with over 90% of working nurses
in the public sector at any one time (Phillips, 1996). It is sometimes
assumed that gender and racial discrimination are less signi®cant in the
public than in the private sector (see Blackaby et al., 1996, for evidence),
and one of our objectives is to investigate that assumption in the context of
nursing. Finally, nursing is a sector in which pay is negotiated at the national
level and pay differentials within grades are small and thus it can be argued
that promotion is the appropriate process to study, rather than pay itself.
In order to gain reliable and robust econometric estimates of the promo-
tion process for NHS nurses, we address a problem with earlier studies of
promotion arising from the inclusion of potentially endogenously deter-
mined regressors in the promotion model. In particular, we question the
assumption of exogeneity for labour market participation history, the num-
ber of training spells and part-time status ± all of which would lead to
biased estimates and incorrect inferences about gender and race inequal-
ities. We start from the conventional ordered probit (OP) model and then
develop a full simultaneous model which allows for the possible endogene-
ity of ®ve important features of the individual's participation and training
history. The unobservable heterogeneity terms linking these variables to the
promotion process is accommodated using simulated maximum likelihood
(SML).
II. DATA AND SAMPLE CHARACTERISTICS
We use data from a 1994 survey of NHS nursing staff conducted by the
Policy Studies Institute for the Department of Health (Beishon et al., 1995).
Data were gathered from postal questionnaire responses to a one-in-three
sample of the permanent nursing staff from a set of 91 NHS employers in
England. Members of the ethnic minorities were deliberately over-sampled.
GENDER AND RACIAL DISCRIMINATION IN PAY AND PROMOTION 803
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